ARFID And Autism With Lauren Sharifi

Avoidant Restrictive Food Intake Disorder (ARFID) is often misunderstood, yet it significantly impacts the lives of many children and their families. In a recent podcast episode, I sat down with Lauren Sharifi to dive into what ARFID is, its subtypes, and the challenges individuals with ARFID face—especially in educational settings. Lauren shares valuable insights on recognizing early signs, the role of sensory sensitivities, and practical strategies to support children with ARFID in a way that respects their unique needs. This conversation highlights the importance of validation, sensory accommodations, and collaboration between parents and educators to create a more inclusive and understanding environment for children with ARFID.

What is ARFID and Why Aren’t We Talking About It More?

Tara: Hey there, Lauren. I'm so thrilled to have you here today to talk about all things ARFID. Thank you so much for agreeing to be on the show!

Lauren: Yeah, thank you so much for having me. I'm excited to be here.

Tara: Can you tell everyone a little bit more about yourself, your background, and what got you into talking about ARFID?

Lauren: Sure! So, I’m a registered dietitian, and my career has taken me in a lot of different directions. Early on, I worked in private practice, mainly focused on eating disorders, but when I had kids, I developed a real interest in family nutrition. That’s when I started seeing individuals with ARFID—both kids and adults—and I realized I knew very little about it. When I was in college, we didn’t learn about ARFID at all. Even as a provider, there was almost no education on it. So, I had to do a deep dive to understand how to support these individuals.

It was frustrating because there weren’t many resources available. I kept hitting dead ends, both for myself and my clients. But I saw a huge need for awareness and support. So, when I left my previous practice in 2022 to start my own, I decided to focus entirely on ARFID. It’s so different from other eating disorders, and I felt like this was where I could really make an impact.

ARFID vs. Picky Eating: What’s the Difference?

Tara: I feel like ARFID is being talked about more and more lately, but there’s still a lot of confusion around it. Some people might be thinking, “Wait, what is ARFID?” while others might have heard of it but don’t understand what it means. I know that even when I was in school, I learned barely anything about autism, and I’ve heard from recent grads that they still aren’t getting much practical education on working with autistic kids. So, like you, many of us have had to learn about these things on our own.

Lauren: Yes, exactly! It’s one of those areas that is so under-discussed, even though it impacts so many people.

Tara: Can you explain what ARFID is and how it differs from typical picky eating, especially in young autistic kids?

Lauren: Absolutely! ARFID stands for Avoidant Restrictive Food Intake Disorder. It’s classified as a disorder in the DSM, but I really see it as more of a disability or a difference—kind of a spectrum of eating challenges that are often tied to neurodivergence.

I see a lot of co-occurrence with autism, ADHD, OCD, and sensory processing differences. And within ARFID, there are three main subtypes:

1. Low Interest/Restrictive Type – These individuals just don’t have much interest in eating. They may not feel hungry often or may find eating to be a chore.
2. Sensory/Avoidant Type – For these individuals, sensory input from food (like textures, smells, and tastes) is overwhelming or even distressing. Some might gag or have an aversive reaction just from being near certain foods.
3. Aversive/Fear-Based Type – This type is more anxiety-driven. The person may have a fear of choking, vomiting, or getting sick from food.

A lot of my clients fall into more than one subtype. For example, I’ve worked with individuals who started with sensory-based ARFID and later developed low-interest ARFID as they grew older. It’s definitely a spectrum and varies from person to person.

Recognizing ARFID in Children: Early Signs to Watch For

Tara: I had no idea there were different subtypes, but now that you explain it, I can totally think of kids I’ve worked with who fit each one. I remember one student early in my teaching career who had a very limited list of foods he would eat. One day, I heated up a frozen meal in my classroom (because, you know, teachers rarely get an actual lunch break), and he immediately ran over, took it, and put it back in the fridge. Then he started gagging! It was clear that something about the smell or look of the food was overwhelming for him.

Lauren: Yes! That’s a classic example of sensory-based ARFID. He knew exactly what he needed to do to get that overwhelming stimulus away from him.

Tara: So, is that one of the early signs of ARFID? What should parents and educators be looking for?

Lauren: Definitely. Some of the early signs of ARFID include:

• Extreme sensory responses to food – Gagging, crying, or even vomiting when exposed to certain smells, textures, or tastes.
• Avoidance behaviors – Not wanting to come to the table or avoiding mealtimes altogether because it’s too overwhelming.
• Limited food variety – Some kids may only eat a handful of foods and resist trying anything new, even over long periods of time.
• Anxiety around eating – This can be especially true for kids who fall into the fear-based ARFID subtype. They may worry that food will make them sick or that they’ll choke.

For young kids, fear-based ARFID might not be as obvious unless they’ve had a traumatic experience, like choking or being tube-fed as a baby. But there’s usually an increased level of anxiety around food that goes beyond typical picky eating.

Creating a Supportive Environment for Kids with ARFID

Tara: I think so many people are going to be saying, “Wow, I know a child who fits this description.” I had a student once who refused to eat at school, but her mom wasn’t worried. She knew her daughter ate at home in her safe space with her safe foods. And she told us, “Don’t pressure her. Let her play. It’s okay.” That was a big learning experience for us because we’re so conditioned to worry when kids don’t eat.

Lauren: That’s so great that the mom advocated for her daughter like that! School can be really challenging for kids with ARFID. It’s not their safe space, there’s sensory overwhelm, and eating just isn’t a priority for them when there are so many other things happening. But the pressure to eat can actually make things worse.

Tara: Yes! And I want to dive deeper into that—how can educators and parents create a supportive, pressure-free environment for kids with ARFID?

Lauren: That’s such an important question! Here are some key strategies:

• Remove pressure from mealtimes – Encouraging kids to eat or making them feel like they “have to” eat can increase anxiety and resistance. Instead, offer food consistently and neutrally.
• Offer safe foods alongside new foods – Having familiar foods available can make mealtimes feel less stressful.
• Respect sensory preferences – If certain textures, smells, or presentations of food are overwhelming, try finding alternatives that still provide similar nutrients.
• Create predictable mealtime routines – Having a routine around meals can help reduce anxiety and make eating feel more manageable.
• Validate their experiences – Instead of saying, “Just try it,” acknowledge their feelings by saying, “I know this food seems tricky for you.”

The key is to make mealtimes feel safe and supportive rather than stressful or forced.

Rethinking Mealtime Expectations in the Classroom

Tara: What would you say to educators who are well-meaning and want to get their students into a routine—like sitting at a table for snack time—because they believe it prepares them for kindergarten? Sometimes, I tell teachers that if a child has an IEP, they’ll be met where they’re at, so we don’t necessarily need to enforce neurotypical standards. But do you have any advice for teachers who worry about this?

Lauren: Absolutely. One key thing is allowing children to eat the foods they feel safe and comfortable with, even if they aren’t what society considers “healthy.” What matters is that the child is nourished. Some kids also need accommodations, like a quieter space, headphones, or even the ability to move around while eating. If walking while eating helps them regulate, and it’s safe in the environment, then that should be supported.

Also, a big one—don’t comment on what a child is or isn’t eating. Just don’t talk about the food at all. Adding pressure or judgment can make eating even harder for them. Many kids already struggle with the realization that they eat differently than their peers. We don’t want to add shame to that experience.

Allowing Flexibility in Eating Schedules

Tara: I love the idea of accommodations, like letting a child move while eating. Many students don’t eat breakfast—not because their parents aren’t feeding them, but because their bodies just aren’t ready for food in the morning. You can’t force someone to eat when they’re not hungry, and you wouldn’t want to. So, these kids come in, and about half an hour later, they’re hungry. They might lead you to the cupboard or use AAC to tell you they want food. Being flexible with that makes such a difference. If we make them wait until the scheduled mealtime, it can throw off their whole day.

Lauren: Exactly! Some kids even have it written into their IEPs that they can pull out a snack whenever they need it. That kind of flexibility can be incredibly helpful.

Tara: And there’s no judgment on parents here. Just like we think about circadian rhythms for sleep, kids have natural rhythms for hunger too. It’s actually a good thing for them to listen to their bodies and eat when they’re hungry.

Lauren: Yes! Although some neurodivergent individuals struggle with interoception, meaning they might not recognize their hunger cues. If they’ve been repeatedly told, “No, it’s not time to eat yet,” they might disconnect from those cues even more. Instead, we can help them recognize and honor their own hunger signals.

Understanding Sensory Sensitivities and ARFID

Tara: How do sensory issues—like texture, taste, and smell—play into Avoidant/Restrictive Food Intake Disorder? How can caregivers tell the difference between a sensory preference and ARFID?

Lauren: Sensory sensitivities in ARFID are like having the volume dial turned way up. A child might experience textures, tastes, and smells much more intensely than others. Certain foods can trigger a disgust response—they just can’t eat them. Adults with ARFID often say, “My brain just says no.” They don’t know why, but they physically can’t bring themselves to eat certain foods.

This is different from a sensory preference, where a child might not like a certain texture but could eat it if necessary. With ARFID, they’d rather go without food entirely than eat something that feels wrong to them.

The Reality of ARFID: It’s Not Just “Picky Eating”

Tara: I had twins in my classroom years ago who definitely had ARFID, but at the time, no one really knew about it. Their mom would say, “People tell me to just not give them Goldfish crackers and wait them out, but they won’t eat anything else. They’ll starve.”

Lauren: Yes, that’s a key sign of ARFID—if their safe foods aren’t available, they simply won’t eat. The typical methods people use with toddlers, like offering a variety of foods and waiting for them to get hungry enough to try something new, don’t work for these kids.

Tara: Right, and it can backfire. If they feel pressured, they might even stop eating the few foods they did feel safe with.

Lauren: Exactly. The more pressure, the worse it gets. Sometimes they’ll even lose a safe food because of the stress around eating. That’s why a no-pressure approach is so important.

Will It Get Better?

Tara: So, does ARFID improve over time? Or is it completely individual?

Lauren: It really depends on the person. Some individuals, as teens or adults, develop the internal motivation to expand their diet, and they do. Others struggle with ARFID their entire lives. Parents always ask me, “Will it get better?” And honestly, I don’t know. I’ve worked with some parents who say, “I was like this as a kid, and I eventually learned to eat more foods.” That insight can be helpful, but there’s no one-size-fits-all answer.

The Takeaway: Supporting Kids Without Pressure

Tara: What are some neurodiversity-affirming strategies to support young autistic kids with ARFID without increasing anxiety? We've touched on a few, but let's recap them.

Lauren: The key is validating their experience, meeting them where they’re at, and understanding their unique needs. Learning about ARFID is helpful, and providing access to safe foods in a supportive environment is crucial. Safe foods might not feel safe in overstimulating settings, so accommodating that is important. Giving kids autonomy in how and where they interact with food, and allowing them to explore new foods at their own pace, is essential. ARFID is often tied to neurodivergence, so it's about managing and supporting, rather than trying to cure it. Meeting them where they are and respecting their process is key.

Tara: Yeah, if parents are concerned about their child's health or weight, seeing a dietitian who specializes in ARFID could be helpful.

Lauren: Having a supportive team is key to making eating more accessible. If a food doesn't provide the necessary nutrients, we can find alternatives that work for their sensory needs and other challenges.

Tara: Parents often blame themselves, but support from a dietitian or someone who understands ARFID can help ease that burden and remind them they didn’t cause it.

Lauren: I love validating parents for the great work they’re already doing. They may fear they’re “giving in,” but they’re actually supporting and accommodating their child in the right way.

Tara: Many parents instinctively do the right things for their child with autism, often without realizing it.

Lauren: Even if society says otherwise, it's okay if dinnertime is tough. Families often feel guilty, but you're doing what's best for your family. You can connect in other ways that feel more comfortable than sitting at the table together.

Support For Children With ARFID At School

Tara: How can educators, especially at the preschool level, support children with ARFID during meal and snack times at school?

Lauren: I think the big one is allowing children to bring foods they’re comfortable with and even consulting with parents about their preferences. If needed, provide a quieter space and accommodate accordingly. Also, avoid commenting on their food choices.

Tara: Let it be. Many elementary schools offer accommodations like quiet spaces or special education classrooms for mealtime. Teachers can also create a “lunch bunch” with a few peers, so kids aren't alone unless they prefer it. For example, we once had a “Polly Pocket lunch club” to make the experience more enjoyable for a student overwhelmed by the lunchroom chaos. It's okay to move away from the traditional lunchroom setting.

Lauren: Yeah, there's no set rules.

Fed Is Best

Tara: What advice do you have for educators, SLPs, or OTs working with families of autistic children who may have ARFID and concerns about food or nutrition? How should they approach parents?

Lauren: If there’s concern, remember “fed is best.” Whatever they can eat is the most important, even if it's just one food. Encourage parents to bring in safe foods to support nutrition. If a child feels safe eating the same thing often, it’s okay as it meets their calorie and nutritional needs. For more serious concerns, a dietitian or specialist can provide additional support.

Tara: This advice opens the door for conversations with parents, like asking if the child’s safe food is why they bring the same thing daily. Being open helps understand what’s happening at home and allows you to replicate the approach.

Lauren: Notice without judgment and find ways to make the eating environment more comfortable, especially if the child isn’t eating at school.

Tara: Thank you, Lauren! This has been a great learning experience.

Listen to the Podcast: Episode #112

You can connect with Lauren here:

instagram.com/arfid.dietician

www.laurensharifi.com

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